Physicians Wade Into Efforts To Curb Unnecessary Treatments

Sun Apr 8 11:02:44 PDT 2012

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California Chapter of the American Academy of Emergency Medicine

April 4, 2012

Physicians Wade Into Efforts To Curb Unnecessary Treatments 

X <Paste before X... Source....ex. Kaiser Health News

By JULIE APPLEBY

Nine prominent physician groups today released lists of 45 common tests and
treatments they say are often unnecessary and may even harm patients.
http://choosingwisely.org/?page_id=13 

The move represents a high-profile effort by physicians to help reduce the
extraordinary amount of unnecessary treatment, said to account for as much
as a third of the $2.6 trillion Americans spend on health care each year. 

Each of the societies, representing both primary care doctors and
specialists, picked five procedures that medical evidence shows have little
or no value for certain conditions, and which they say should be questioned
by patients and their doctors. 

The list includes such common practices as routine electrocardiograms for
patients at low risk for heart disease, and antibiotics for mild sinus
infections. It is meant as a set of guidelines.

Dr. Donald Berwick, the former head of Medicare and a longtime quality
researcher, called the campaign "a game changer." Part of the reason is that
patients generally trust doctors more than insurers, employers or others who
attempt to influence what gets covered and what doesn't.

"This could be a turning point if it's approached with energy," Berwick
says. "Here you have scientifically grounded guidance from a number of major
specialty societies addressing a very important problem, which is the
overuse of ineffective care."

For the most part, the list is non-controversial, avoiding such hot-button
issues as prostate-specific antigen testing for prostate cancer, or how
often to perform mammography screenings for breast cancer.

But the items on the list include a broad range of interventions that can be
revenue-generating for doctors, clinics and hospitals -- and costly for
insurers and patients. Some also pose health risks to patients, because they
may lead to additional radiation exposure, side effects from medications or
unneeded surgeries.

"We need to use this opportunity to raise awareness that sometimes
overtreatment or testing can be harmful," says Glen Stream, president of the
American Academy of Family Physicians, one of the nine specialty groups
participating.

The campaign comes amid a variety of efforts - some called for in the
federal health law - to compare the effectiveness of treatments and to
change payment incentives to doctors and hospitals to reward quality and
penalize inefficiency 

But efforts to slow medical spending growth often become political, spurring
fears of rationing or "death panels."

"Anytime you are recommending against a test or treatment, people wonder 'is
it for some economic interest?'" notes Stream, who says the evidence-based
recommendations are designed to counter those concerns.

Among the items the groups recommend doctors and patients question: X-rays
or other scans for uncomplicated headaches or early evaluation of low back
pain, exercise electrocardiograms, often called "stress tests" or "treadmill
tests" for low-risk patients with no symptoms of heart disease, and
chemotherapy for patients with advanced solid-tumor cancers who are unlikely
to benefit.

Some of the recommendations go against financial self-interest of the
societies or their members because they are likely to result in fewer tests
or procedures, Berwick notes. Because of that, some policy experts question
whether physician groups will tackle the problem enthusiastically. 

A 2011 study in the British Medical Journal, for example, found financial
conflicts of interest among many of the doctors charged with drawing up
clinical guidelines for diabetes and cholesterol treatments in the U.S. and
Canada. 

Nonetheless, physicians are becoming more involved in efforts to spread the
message that more care is not always better. Other recent efforts to
identify medically unnecessary treatments include 37 listed by the American
College of Physicians in the Annals of Internal Medicine in January.

And in 2008, the National Priorities Partnership - a collaboration of 28
national health care organizations released its own analysis of overused
services, including Caesarean-section deliveries and chemotherapy given to
patients in the last two weeks of their lives. 

The new campaign, called "Choosing Wisely," is funded by the ABIM
Foundation, an arm of the American Board of Internal Medicine. The
recommendations will be featured on the website of Consumer Reports
magazine, which partnered with the foundation. 

Educational materials will be distributed to physicians. The specialty
societies in the campaign include those representing family physicians,
cancer doctors, cardiologists, radiologists, gastroenterologists, allergists
and kidney specialists. Another eight specialty groups - representing
rheumatologists, pathologists, head and neck surgeons and others - are
expected to release their own lists in the fall. 

While calling the campaign "magnificent and long overdue," another quality
expert noted that most physicians are already aware that most listed
procedures are overused.

"This is important, but obviously a first step ... classic low-hanging
fruit," says Steve Pearson, president of the Institute for Clinical and
Economic Review, which evaluates medical treatments and is affiliated with
Harvard Medical School.

He adds that many would find it remarkable that "it's still required to tell
physicians not to do these things."

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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